Neoadjuvant therapy or upfront surgery? A systematic review and meta-analysis of T2N0 esophageal cancer treatment options

Mota, Filippe; Cecconello, Ivan; Takeda, Flávio Roberto; Tustumi, Francisco; Sallum, Rubens Antônio Aissar; Bernardo, Wanderley Marques

doi:10.1016/j.ijsu.2018.04.053

Cited by 33 publications

(31 citation statements)

References 31 publications

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“…However, following neoadjuvant chemoradiotherapy, a certain proportion of ESCC patients do not respond to chemoradiotherapy 38,39 . Studies have found that neoadjuvant therapy is not associated with better results than surgery alone in ESCC patients 40,41 . However, the patients included in this study did not receive neoadjuvant chemoradiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Smoking behavior and smoking index as prognostic indicators for patients with esophageal squamous cell carcinoma who underwent surgery: A large cohort study in Guangzhou, China

Liu¹,

Huang²,

Liao³

et al. 2020

Tob. Induc. Dis.

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INTRODUCTION This study aimed to evaluate the association between smoking and smoking index with clinical outcomes of esophageal squamous cell carcinoma patients. METHODS This is a retrospective analysis conducted on consecutive patients with esophageal carcinoma who underwent esophagectomy from January 2005 to December 2010. All patients had pathologically confirmed esophageal squamous cell carcinoma. The association between smoking and sociodemographic characteristics with overall survival and disease-free survival was analyzed. Serum carcinoembryonic antigen was measured using an electrochemiluminescence immunoassay. RESULTS A total of 944 patients were enrolled. Kaplan-Meier analysis indicated that esophageal squamous cell carcinoma patients who smoked had a significantly worse prognosis in terms of both overall survival (p=0.007) and disease-free survival (p= 0.010). Multivariate analysis demonstrated that age (p=0.001), carcinoembryonic antigen (p=0.012), tumor-node-metastasis (TNM) staging (p<0.001) and smoking (p=0.048) were independently correlated with overall survival, while only TNM stage (p<0.001) and smoking (p=0.041) were identified as independent factors of disease-free survival. We divided the smoking population into two groups (smoking index <400 and ≥400). Kaplan-Meier survival analysis indicated that a smoking index <400 was associated with a significantly better prognosis in terms of both overall survival (p=0.003) and favorable disease-free survival (p=0.032). Multivariate analysis showed that age (p<0.001), TNM staging (p<0.001), and smoking index (p=0.025) were independent factors of overall survival, whereas for disease-free survival, only TNM stage (p=0.001) and smoking index (p=0.025) were identified. CONCLUSIONS Overall survival was significantly associated with smoking in esophageal squamous cell carcinoma patients. For esophageal squamous cell carcinoma patients who smoke, a higher smoking index is associated with worse clinical outcomes. Therefore, smoking may be used as a predictive indicator for pretreatment evaluation and adjustment of treatment regimen.

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Section: Discussionmentioning

confidence: 99%

Smoking behavior and smoking index as prognostic indicators for patients with esophageal squamous cell carcinoma who underwent surgery: A large cohort study in Guangzhou, China

Liu¹,

Huang²,

Liao³

et al. 2020

Tob. Induc. Dis.

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“…10 Regarding locally advanced esophageal cancer, neoadjuvant therapy has been proven to yield better results and is currently considered the standard therapy. 11,12 In the setting of neoadjuvant therapy, only a few studies examined the relationship between prognostic variables and the change of these variables during neoadjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

Variables Associated to Pathologic Complete Response, Overall Survival and Disease-Free Survival in the Neoadjuvant Setting for Esophageal Cancer: A Retrospective Cohort Analysis

Takeda

Viyuela

Cruz

et al. 2018

International Surgery

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Objective: The aim of the study was to evaluate prognostic factors during neoadjuvant therapy that can predict pathologic complete response (pCR), overall survival (OS), or disease-free survival (DFS). Summary of background data:Variables that can predict tumor response to neoadjuvant therapy are required for esophageal cancer management.Methods: A retrospective cohort was performed with esophageal cancer patients submitted to neoadjuvant therapy. pCR, OS, and DFS were evaluated. Logistic regression was used to evaluate prognostic factors. This study covered 140 patients, 94 squamous cell carcinomas (SCC), and 44 adenocarcinomas. SCC is more often associated with pCR (compared to adenocarcinoma, OR: 8.07, 95% CI: 2.91-22.38); it has higher probability of DFS (HR for death or recurrence was 0.6, 95% CI: 0.37-0.98); and a higher probability of OS (HR for death was 0.59, 95% CI: 0.35-1). Gender, age, grade of cellular differentiation, chemotherapy regimen, and neoplasm circumferential involvement before neoadjuvant therapy are variables that are unrelated to DFS. Relief of dysphagia, and weight gain were also unrelated to the outcomes. In the multivariate analysis, the weight loss during neoadjuvant therapy was related to higher risk for recurrence or death (HR 1.02, 95% CI: 1-

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“…Since the CROSS Group reported good results of neoadjuvant therapy based on carboplatin and paclitaxel, preoperative chemoradiotherapy is the mainstay treatment among most patients with potentially curable esophageal cancer …”

Section: Introductionmentioning

confidence: 99%

“…Since the CROSS Group 14 reported good results of neoadjuvant therapy based on carboplatin and paclitaxel, preoperative chemoradiotherapy is the mainstay treatment among most patients with potentially curable esophageal cancer. 14,15 The prognosis value of cellular blood components changes during neoadjuvant chemoradiotherapy using a platinum-and taxane-based regimen followed by curative intent esophagectomy for esophageal cancer in predicting survival, recurrence, and pathological response to neoadjuvant therapy has not been reported and is the aim of this study.…”

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confidence: 99%

The value of cellular components of blood in the setting of trimodal therapy for esophageal cancer

Tustumi

Takeda

Viyuela

et al. 2019

Journal of Surgical Oncology

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Background Inflammation status plays an important role in the natural history of malignancy. Consequently, hematological markers of systemic inflammation may predict prognosis in neoplasms. This study evaluated the value of cellular blood components changes during neoadjuvant chemoradiotherapy followed by esophagectomy for cancer in predicting prognosis. Methods A cohort of 149 patients was analyzed. Cellular components of blood were assessed before neoadjuvant therapy (A); before surgery (B); and 3 to 5 months after surgery (C); for the following outcomes: pathological response, overall survival (OS), and disease‐free survival (DFS). Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of blood count variables. Results Low hematocrit (Ht) (C) (HR, 0.85; 95% CI, 0.79‐0.92) and high neutrophil‐to‐lymphocyte ratio (NLR) (C) (HR, 1.07; 95% CI, 1.07‐1.10) were related to poor OS. Low Hb (C) (HR, 0.72; 95% CI, 0.58‐0.88), red cell distribution width (RDW) (C‐A) (HR, 1.16; 95% CI, 1.02‐1.31), and NLR (C‐A) (1.06; 95% CI, 1.03‐1.09) were related to poor DFS. RDW (B‐A) (HR, 1.15; 95% CI, 1.08‐1.22), RDW (C) (HR, 1.12; 95% CI, 1.04‐1.2), NLR (C) (HR, 1.12; 95% CI, 1.08‐1.17) were related to systemic recurrence. Conclusion Variables of routine blood count are easily assessable and their changes throughout trimodal therapy for esophageal carcinoma provide important information for cancer patient's prognosis.

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Neoadjuvant therapy or upfront surgery? A systematic review and meta-analysis of T2N0 esophageal cancer treatment options

Cited by 33 publications

References 31 publications

Smoking behavior and smoking index as prognostic indicators for patients with esophageal squamous cell carcinoma who underwent surgery: A large cohort study in Guangzhou, China

Smoking behavior and smoking index as prognostic indicators for patients with esophageal squamous cell carcinoma who underwent surgery: A large cohort study in Guangzhou, China

Variables Associated to Pathologic Complete Response, Overall Survival and Disease-Free Survival in the Neoadjuvant Setting for Esophageal Cancer: A Retrospective Cohort Analysis

The value of cellular components of blood in the setting of trimodal therapy for esophageal cancer

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